CPAP and Parkinson's Disease

To Sleep, To Sleep, Perchance to Dream
Ivan M. Suzman

Only a minority of people with Parkinson's (PWP's) achieve refreshing, regular sleep patterns. Dr Cynthia Comella, M.D., a sleep specialist and Parkinson's expert at Rush-Presbyterian St. Luke's Medical Center in Chicago (a leading center supported by the Parkinson's Disease Foundation) estimates that as many as 70 percent of PWP's are vulnerable to episodes of sleep displacement and fragmentation.

Here are a few ideas that PWP's may consider to improve sleep quality.

Bed Linens Can Improve Mobility

Mrs. Bill L.W. Bird of Marcus, Iowa, recommends using a fitted satin bottom sheet, so that her husband can "slide around and turn over" more easily. Mrs. Bird located good sheets in the J.C. Penny mail-order catalogue at $39.00 for a set of two sheets and two pillow cases. I found some at http://www.carolwrightgifts.com, which cost just $24.95 for two sheets and $4.95 for two pillowcases. Mr. Nigel Harland of the United Kingdom adds that wearing satin boxer shorts can also increase bed mobility, especially rolling-over.

Mrs. Virginia Wilson of South Carolina states that her husband can see the edges of unmatched sheets or pillow cases better than matched ones and thus grasp them more quickly when he needs to shift them around. Her card ends, "forget matching and go complementary!"

I enjoy adding an electric blanket to the top covers, which I limit to the sheet, the single blanket and a thinner, summer-weight spread. Toes are less likely to curl up, and sleep will come sooner, in a bed that has warm, easily movable top covers.

Preparing Yourself for Sleep

Meditation or bedside prayers help many people to prepare and soothe the spirit for sleep. You may also benefit from soaking in a warm bath, especially if you experience toe curls or calf-muscle cramps. Treat yourself by including your favorite bath salts (avoiding oil-based products that can make the bathtub slippery).

Naturally-decaffeinated teas that tend to relax the stomach may help you feel sleepy. A brand I personally enjoy is "Sleepytime" from Celestial Seasonings Herb Tea. A box of twenty teabags costs $2.79 at my local supermarket or $5.98 for two boxes online at http://www.celestialseasonings.com.

Create a Cozy Environment

In recent years, there has been a huge growth in the availability of pre-recorded music for relaxation. http://www.amazon.com lists hundreds of CDs that offer peaceful sounds, from the tranquil pinging of the harp to the gentle patter of rainfall. Three different models of "Sound Soothers" table-top speakers, pre-programmed with 20 different sounds - are available from "The Sharper Image" (http://www.sharperimage.com or (800) 344 - 4444, prices start at $69.95), bringing into your bedroom the serenity of the oceanside or a summer night.

Keeping an oft-read book next to your bed to help you drift back to sleep after a mid-night awakening is preferable to switching on the television which can be too stimulating.

Easily found at your local hardware store, a soft, ivory or light yellow night light, placed just outside the door of the bedroom, can illuminate the way to the nearest bathroom, while not being invasive. It's especially helpful if you experience visual illusions with too much darkness.

Timing Your Medications

Timing your medications to avoid nighttime 'wearing-off' is important because muscle rigidity is one of the symptoms of PD that can interfere with a good night's sleep. I suggest that each PWP work out the best possible dose times to avoid losing sleep. This becomes even more important as the disease progresses. Your neurologist and your caregivers can be of enormous help in monitoring your response to dosages and schedules.

One commonly prescribed medication has long been known to cause insomnia. For this reason, my neurologist advises that Eldepryl (selegiline) should be taken no later than noon, in most cases. Its half-life of 17 hours leaves some active medication in the system, which will continue to be converted - even beyond midnight - into a methamphetamine-like product. This process can disrupt sleep.

Snorers have special needs

Aggravated, loud nasal breathing can foil the most ardent attempts to sleeping quietly and comfortably. One possible remedy is to raise the upper body on pillows, or on a foam wedge, available from medical supply catalogues. There are three different heights for foam slants and they cost from $24.95 to $42.95 (see http://www.brucemedical.com).

Betty Copeland of Manhattan reports great success with nasal strips that dilate the nostrils and improve inhalation. She recommends the plain, cloth-like, tan strips that are available from BreatheRight, Inc. These can be found easily at most good drug stores. Or try http://www.cvs.com where they cost $5.49 for a dozen.

Sleep Disturbances
Most people with Parkinson’s find it difficult to sleep through the night. Rigid muscles, tremors or stiffness at night, or not being able to roll over in bed can all interfere with sleep, as can the frequent urge to urinate. In addition, many people with Parkinson’s experience vivid dreams or hallucinations and act out their dreams, violent nightmares, a problem called “REM sleep behavior disorder.” Recent research suggests that REM sleep behavior disorder sometimes begins even before motor symptoms are diagnosed in Parkinson’s.

Medicine, such as clonazepam, is available for this problem. For some people, an extra dose of anti-Parkinson medications or a sleeping medication can help alleviate sleep disturbances. In other cases, sleep disturbances may be caused by medical conditions not related to PD. For example, a disruption in breathing called sleep apnea can also interfere with sleep, and can be treated separately from PD. Getting a good night’s sleep is essential for people with Parkinson’s, so if you are having any of these symptoms you should discuss them with your doctor.

Not sleeping well at night often causes people with Parkinson’s to feel drowsy during the day. Anti-Parkinson medications and the disease itself can also contribute to excessive daytime sleepiness. A pattern of falling asleep suddenly for short periods of time, similar to narcolepsy, can interfere with daily life. Adjusting antiparkinson medications, or taking a stimulant during the day—under a doctor’s supervision, of course—may help alleviate sleepiness during the day.

ozij wrote:The point being that the parkinson induce sleep disturbances are not necessarily those caused by sleep apnea.